Canadians With Diabetes Need Better Access To Vision-Saving Eye Care

A diabetic patient at the South Riverdale Community Health Centre undergoes the screening program for detection of diabetic retinopathy. Photos: Max Rosenstein

Photos: Max Rosenstein

Photos: Max Rosenstein

Rebecca Merritt (middle) with two members of her team at the SRCHC. Photos: Max Rosenstein

O

ver 3 million Canadians live with diabetes and, of the many complications the disease can cause, vision loss from diabetic retinopathy is one of the most preventable. Yet for many diabetic Canadians, access to the eye care and regular screenings that could safeguard their vision has remained elusive. A program at the South Riverdale Community Health Centre (SRCHC) is working to change that.

“Sight-threatening diabetic retinopathy and blindness are quite preventable, so it’s important that people with diabetes get screened regularly,” says Dr. Michael Brent, an associate professor of ophthalmology at the University of Toronto. “Data from a recent study by the Institute for Clinical Evaluative Sciences in Toronto discovered that more than 400,000 Canadians living with diabetes had not had a single eye screening test over a two-year period, whereas we recommend annual screenings. The areas with the poorest screening rates are in large cities, in low-income communities, and in indigenous communities.”

Building the bridge

Seeking to bridge this gap in care, Dr. Brent contacted the SRCHC, an organization in Toronto that serves a very large patient population and focuses primarily on disadvantaged groups who face barriers accessing health services. “Even in the GTA, despite there being excellent access to optometrists and ophthalmologists, people are still under-screened,” says Rebecca Merritt, Manager of the Service Administration and Quality Team at the SRCHC. “There are still barriers to people getting the care they need.”

Together, Dr. Brent and the SRCHC piloted a program to reach out to and serve as many of these under-screened patients as possible. When a client comes in for a screening under this program, they first receive a visual acuity test, followed by a test of their eye pressure, and then finally a dilating eye drop so that a technician can take high resolution photos of their retina. The whole appointment takes about 40 minutes. And then the magic happens. “We use the Ontario Telemedicine Network (OTN) to securely transfer the information to a retina specialist,” says Merritt. “The specialist reviews the images and notes from the clinical assistant and makes a recommendation, which is securely transmitted back to us via the OTN. That recommendation is then forwarded to the client’s primary care provider.” This allows the SRCHC to leverage their existing staff to effectively let them operate as though they had a retinal specialist on site.

At risk without knowing it

Since launching in December of 2013, the program has screened over 650 patients at five sites. For many, it was their first eye screening since being diagnosed with diabetes. Roughly 60 percent of those screened showed some pathology of the eye, with 19 percent presenting moderate to severe diabetic retinopathy. That’s over a hundred Canadians who were at risk of losing their vision without knowing it, and without knowing anything could be done about it. And many of them had no idea. “Often people are asymptomatic as the disease progresses,” says Dr. Brent. “By the time they notice symptoms, the disease can be quite advanced. If you don’t have treatment for diabetic retinopathy, you are at risk of going blind. But the treatments are very good now, with a high success rate in preserving vision.”

One of the fundamental challenges in our health care system is bringing effective screening and treatment to those who need it most, and this program provides one shining example of how that can be successfully done.